Warning: session_start(): Cannot send session cookie - headers already sent by (output started at /home/physio/public_html/blog/wp-content/themes/physiocouk/single.php:7) in /home/physio/public_html/includes/cookie.php on line 3

Warning: session_start(): Cannot send session cache limiter - headers already sent (output started at /home/physio/public_html/blog/wp-content/themes/physiocouk/single.php:7) in /home/physio/public_html/includes/cookie.php on line 3
Understanding-persistent-pain | Blog | Physio.co.uk | Leading physiotherapy provider in Liverpool and Manchester.

Please note: Our Online Booking tool is currently down, please contact us on 0330 088 7800 to arrange your appointment and we will honour any online booking discount.


  • Book now

we work with

  • Individuals

  • Solicitors

  • Case

  • Intermediaries

  • Organisations

  • Health


  • Our Clinics


  • Contact us

Close Icon
Deansgate (Manchester) »
3-5 St John Street, Manchester, M3 4DN
  0330 088 7800
Piccadilly (Manchester) »
6 Minshull Street, Manchester, M1 3ED
  0330 088 7800
Stockport »
9 Mealhouse Brow, Stockport, Cheshire, SK1 1JP
  0330 088 7800
Macclesfield »
36 Charlotte Street, Macclesfield, SK11 6JB
  0330 088 7800
Southport »
150 Lord Street, Southport, Merseyside, PR9 0NP
  0330 088 7800
Sale »
17 Claremont Road, Sale, Cheshire, M33 7DZ
  0330 088 7800
Tameside »
West Pennine Consulting Rooms, Pennine Drive, Ashton under Lyne, OL6 9SE
  0330 088 7800
Rodney St (Liverpool) »
88 Rodney Street, Liverpool, Merseyside, L1 9AR
  0330 088 7800
Speke (Liverpool) »
David Lloyd, 6 The Aerodrome Speke, Liverpool, Speke L24 8QD
  0330 088 7800
Eccles »
86 Worsley Road, Eccles, Manchester, M30 8LS
  0330 088 7800
Rochdale »
The Strand Medical Centre, The Strand, Kirkholt, Rochdale, OL11 2JG
  0330 088 7800
Find your nearest clinic »
See our clinics on a map

Simple Pain

Pain is actually a wonderful thing.

It is an alarm signal to warn us we may have tissue damage so it could be an idea to do something about it; either stop what you are doing or move away from that position.

Pain stops us from doing dangerous and silly things; nobody in their right mind would go running on a broken ankle.

This is acute pain and is associated with actual tissue damage and inflammation. It usually settles down as things start to heal, which normally takes up to 3 months with most injuries, even severe ones.

Pain can be a little more complicated though!

Sometimes this alarm system can become a little disrupted or inaccurate.

For example, have you ever had a small cut on your arm go un-noticed for a while? It doesn’t hurt while un-noticed but when you see the blood for the first time it really starts to hurt!!

So, to be a little bit more accurate – pain is a response to what your brain believes to be a threatening situation. If the brain believes there is no real threat then it won’t really hurt, no matter what is happening to the tissues.

Unfortunately, the opposite can also happen.

Sometimes there is no actual tissue damage but the brain thinks there is a danger present and pain can be created in the brain.

Furthermore, this perception part is so complicated because it varies from person to person. Every person’s experience is unique because of his or her history and the current context of the situation.

So how does it work?

If we break it down into stages, we can see it is not as straight forward as it seems…

Firstly, we have a stimulus from the soft tissues in your body (ie you stub your toe). This is sent as a nerve impulse to the spinal cord and then up to the brain. Once arriving in the brain it is sent around different parts of the brain to realise the context of what has happened.

The brain weights up – how important is this event? Are we in danger? Will this affect our job? Have we done this before and how did it end up last time? What do we believe about this condition? Has this made me emotional? Anxious? Upset?

When it finally settles on the interpretation of the signal and so decides upon the pain experience, the pain type and severity is produced.

If we understand that pain is NOT merely a signal that 100% correlates to the amount of actual tissue damage and RATHER a subjective experience with many other factors, then we can start to manage pain more effectively… see below definitions:

‘Pain is subjective, individual and modified by degrees of attention, emotional state and the conditioning of influences of past experience.’ – Livingstone, 1943

‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ – International Association for the Study of Pain, 1983

‘Pain is more than just a sensation, it is an experience’ – Ben Cormack

All these statements about pain are accurate but varied, which shows how complicated it is to define and categorise pain and its impact upon the person who is suffering from it!

Persistent Pain

As discussed, the system sometimes is not always accurate and serving its purpose. Often the pain experience continues long after the original tissue damage has healed (normally up to 3 months). In which case we have now termed it Persistent Pain.

Persistent pain can be debilitating and really get in the way of the quality of life so in order to treat it we need to begin to understand the causes and mechanisms that are responsible for it. This begins with an understanding that the pain is not so much about a problem with the tissues but more so the central nervous system.

What is happening in the nervous system?

Sensitive nerves

For a nerve signal to fire to the spinal cord there needs to be neurotransmitters released around the end of the nerve. If there are enough of the neurotransmitter then the signal is sent. After injury there is a chemical change around the end of the nerves meaning that the amount of neurotransmitters needed to send the signal is reduced.

This makes sense for the period that we have the soft tissue injury. It means we need to slow down and be mindful about movement so that the tissues can heal properly. However, this system can also malfunction after the tissue healing has taken place.

The sensitivity can continue to increase, meaning that even safe and harmless stimuli can trigger a pain response. This is known as hyperalgesia. There can also be an increased sensitivity to heat and touch stimuli, known as allodonia.

For example, a completely safe stimulation such as a gentle stroke to the skin may be interpreted as pain in people who are suffering from the above issues.

This can become difficult to deal with but fortunately, by understanding pain mechanisms and biology, we can alter this pain experience and treat it effectively.

Top down medicine cabinet

Sometimes pain can be neutralised depending on context.

Imagine a soldier who has severe tissue damage in the form of a huge laceration in his leg.

Now normally that would be excruciatingly painful, but in the context that he or she is in, then the brain could produce some naturally occurring pain killers which supresses the pain in order to get back on his/her feet and get out of there.

In this case the brain is able to supress the pain signals by accessing its own medicine cabinet. All of our brains store opioids and endorphins that can be released as effective painkillers. These in effect block the sites of the neuro transmitters that are involved in pain pathways so that the strength of the signal to the central nervous system is supressed.

We also understand that hormones like serotonin have a positive effect on pain. Serotonin is released when we are in a good mood. Continuous stimulation to secrete these brain stored neurotransmitters can modulate pain and restore the normal settings of the nerves.

How do we access this medicine cabinet?

Knowledge and understanding

There is strong evidence to show that an improved understanding of pain leads to increased chemical descending modulation. If we understand that there is not ‘actual’ tissue damage, then we can begin to suppress the unhelpful mechanisms involved in persistent pain.

Aerobic Exercise

Gentle exercise produces blood flow and promotes the release of chemicals that reducing stress levels and ultimately reduce pain levels. In fact, aerobic exercise is generally cited as the most effective and best-evidenced method of addressing the presence longstanding pain.

Addressing additional issues

Research has proven that pain is amplified by stress, anxiety and depression. This means that in order to initiate a change in symptoms, these factors should be addressed specifically.

As the motivational speaker Antony Robbins says – ‘nothing changes if nothing changes’, therefore if we identify the presence of these issues then we need to make a decision about what to do next – action or no action. Your physiotherapist will help assist you with identifying such issues and recommend strategies to assist with them.

Start small and build from there

It is important to begin with simple activities and build up gradually.

Flare-ups in symptoms are normal and to be expected. By allowing the presence of pain to disrupt your activity levels, it may lead to becoming deconditioned and actually increasing the presence of pain during normal everyday activities.

It is therefore important to remain active and incrementally increase your ability with graded exposure to exercise, as opposed to short, intense bouts of activity followed by periods of increased pain.

We should make every attempt to make small incremental changes to swap from the cycle on the left to the cycle on the right.

How can I get the ball rolling?

To begin to understand the causes of your long-standing pain, it is important be assessed by an experienced health professional who can provide you with the appropriate type of management.

The above strategies are likely to be incorporated into a rehabilitation plan by your physiotherapist- as you begin to make improvements, the momentum will increase and the presence of pain will begin to reduce.

If you are interested in any of the above and would like to discuss this further, please contact us on 0330 088 7800 or visit physio.co.uk